|
HC COMP BURN GARM REINFORCEMENTS
|
Facility
|
OP
|
$12.48
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300041
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$435.30 |
| Rate for Payer: Aetna Commercial |
$10.61
|
| Rate for Payer: Aetna Medicare |
$6.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.11
|
| Rate for Payer: BCBS Complete |
$4.99
|
| Rate for Payer: BCBS Trust/PPO |
$435.30
|
| Rate for Payer: BCN Commercial |
$435.30
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Advantage |
$8.74
|
| Rate for Payer: Cofinity Commercial |
$10.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$11.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.36
|
| Rate for Payer: PHP Commercial |
$10.61
|
| Rate for Payer: Priority Health SBD |
$7.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.11
|
| Rate for Payer: UHC Core |
$6.50
|
| Rate for Payer: UHC Exchange |
$4.90
|
|
|
HC COMP BURN GARM REINF SET HK&LO
|
Facility
|
IP
|
$10.40
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.76
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Advantage |
$7.28
|
| Rate for Payer: Cofinity Commercial |
$8.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$9.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.80
|
| Rate for Payer: PHP Commercial |
$8.84
|
| Rate for Payer: Priority Health SBD |
$6.55
|
|
|
HC COMP BURN GARM REINF SET HK&LO
|
Facility
|
OP
|
$10.40
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$435.30 |
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: Aetna Medicare |
$5.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.76
|
| Rate for Payer: BCBS Complete |
$4.16
|
| Rate for Payer: BCBS Trust/PPO |
$435.30
|
| Rate for Payer: BCN Commercial |
$435.30
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Advantage |
$7.28
|
| Rate for Payer: Cofinity Commercial |
$8.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$9.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.80
|
| Rate for Payer: PHP Commercial |
$8.84
|
| Rate for Payer: Priority Health SBD |
$6.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.76
|
| Rate for Payer: UHC Core |
$5.42
|
| Rate for Payer: UHC Exchange |
$4.09
|
|
|
HC COMP BURN GARM SHOULD FLAP REG
|
Facility
|
IP
|
$35.37
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300042
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.28 |
| Max. Negotiated Rate |
$31.83 |
| Rate for Payer: Aetna Commercial |
$30.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.99
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Advantage |
$24.76
|
| Rate for Payer: Cofinity Commercial |
$30.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Healthscope Commercial |
$31.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.53
|
| Rate for Payer: PHP Commercial |
$30.06
|
| Rate for Payer: Priority Health SBD |
$22.28
|
|
|
HC COMP BURN GARM SHOULD FLAP REG
|
Facility
|
OP
|
$35.37
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300042
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.90 |
| Max. Negotiated Rate |
$435.30 |
| Rate for Payer: Aetna Commercial |
$30.06
|
| Rate for Payer: Aetna Medicare |
$17.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.99
|
| Rate for Payer: BCBS Complete |
$14.15
|
| Rate for Payer: BCBS Trust/PPO |
$435.30
|
| Rate for Payer: BCN Commercial |
$435.30
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Advantage |
$24.76
|
| Rate for Payer: Cofinity Commercial |
$30.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Healthscope Commercial |
$31.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.53
|
| Rate for Payer: PHP Commercial |
$30.06
|
| Rate for Payer: Priority Health SBD |
$22.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.99
|
| Rate for Payer: UHC Core |
$18.43
|
| Rate for Payer: UHC Exchange |
$13.90
|
|
|
HC COMP BURN GARM SILON-TEX P/D-G
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Advantage |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health SBD |
$39.32
|
|
|
HC COMP BURN GARM SILON-TEX P/D-G
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.53 |
| Max. Negotiated Rate |
$435.30 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$31.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: BCBS Complete |
$24.97
|
| Rate for Payer: BCBS Trust/PPO |
$435.30
|
| Rate for Payer: BCN Commercial |
$435.30
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Advantage |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.57
|
| Rate for Payer: UHC Core |
$32.52
|
| Rate for Payer: UHC Exchange |
$24.53
|
|
|
HC COMP BURN GARM SILON-TEX UP TO
|
Facility
|
IP
|
$37.45
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300045
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.34
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Advantage |
$26.21
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.09
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: Priority Health SBD |
$23.59
|
|
|
HC COMP BURN GARM SILON-TEX UP TO
|
Facility
|
OP
|
$37.45
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300045
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$435.30 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna Medicare |
$18.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.34
|
| Rate for Payer: BCBS Complete |
$14.98
|
| Rate for Payer: BCBS Trust/PPO |
$435.30
|
| Rate for Payer: BCN Commercial |
$435.30
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Advantage |
$26.21
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.09
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: Priority Health SBD |
$23.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.34
|
| Rate for Payer: UHC Core |
$19.51
|
| Rate for Payer: UHC Exchange |
$14.72
|
|
|
HC COMP BURN GARM SILON-TEX WHOL
|
Facility
|
OP
|
$87.39
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300046
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.34 |
| Max. Negotiated Rate |
$435.30 |
| Rate for Payer: Aetna Commercial |
$74.28
|
| Rate for Payer: Aetna Medicare |
$43.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.80
|
| Rate for Payer: BCBS Complete |
$34.96
|
| Rate for Payer: BCBS Trust/PPO |
$435.30
|
| Rate for Payer: BCN Commercial |
$435.30
|
| Rate for Payer: Cash Price |
$69.91
|
| Rate for Payer: Cash Price |
$69.91
|
| Rate for Payer: Cofinity Advantage |
$61.17
|
| Rate for Payer: Cofinity Commercial |
$75.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.91
|
| Rate for Payer: Healthscope Commercial |
$78.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.54
|
| Rate for Payer: PHP Commercial |
$74.28
|
| Rate for Payer: Priority Health SBD |
$55.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.80
|
| Rate for Payer: UHC Core |
$45.53
|
| Rate for Payer: UHC Exchange |
$34.34
|
|
|
HC COMP BURN GARM SILON-TEX WHOL
|
Facility
|
IP
|
$87.39
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300046
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$55.06 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Aetna Commercial |
$74.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.80
|
| Rate for Payer: Cash Price |
$69.91
|
| Rate for Payer: Cofinity Advantage |
$61.17
|
| Rate for Payer: Cofinity Commercial |
$75.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.91
|
| Rate for Payer: Healthscope Commercial |
$78.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.54
|
| Rate for Payer: PHP Commercial |
$74.28
|
| Rate for Payer: Priority Health SBD |
$55.06
|
|
|
HC COMP BURN GARM SLEEVE WRIST/AX
|
Facility
|
IP
|
$72.83
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300047
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.34
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Advantage |
$50.98
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.62
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: Priority Health SBD |
$45.88
|
|
|
HC COMP BURN GARM SLEEVE WRIST/AX
|
Facility
|
OP
|
$72.83
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300047
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.62 |
| Max. Negotiated Rate |
$435.30 |
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: Aetna Medicare |
$36.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.34
|
| Rate for Payer: BCBS Complete |
$29.13
|
| Rate for Payer: BCBS Trust/PPO |
$435.30
|
| Rate for Payer: BCN Commercial |
$435.30
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Advantage |
$50.98
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.62
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: Priority Health SBD |
$45.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.34
|
| Rate for Payer: UHC Core |
$37.94
|
| Rate for Payer: UHC Exchange |
$28.62
|
|
|
HC COMP BURN GARM SLV WRST-ELB/EL
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300048
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Advantage |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health SBD |
$39.32
|
|
|
HC COMP BURN GARM SLV WRST-ELB/EL
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300048
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.53 |
| Max. Negotiated Rate |
$435.30 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$31.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: BCBS Complete |
$24.97
|
| Rate for Payer: BCBS Trust/PPO |
$435.30
|
| Rate for Payer: BCN Commercial |
$435.30
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Advantage |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.57
|
| Rate for Payer: UHC Core |
$32.52
|
| Rate for Payer: UHC Exchange |
$24.53
|
|
|
HC COMP BURN GARM STERNAL STRAP
|
Facility
|
OP
|
$70.75
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$435.30 |
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna Medicare |
$35.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.99
|
| Rate for Payer: BCBS Complete |
$28.30
|
| Rate for Payer: BCBS Trust/PPO |
$435.30
|
| Rate for Payer: BCN Commercial |
$435.30
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Advantage |
$49.52
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.06
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: Priority Health SBD |
$44.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.99
|
| Rate for Payer: UHC Core |
$36.86
|
| Rate for Payer: UHC Exchange |
$27.80
|
|
|
HC COMP BURN GARM STERNAL STRAP
|
Facility
|
IP
|
$70.75
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.57 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.99
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Advantage |
$49.52
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.06
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: Priority Health SBD |
$44.57
|
|
|
HC COMP BURN GARM STKNG KNEE TO T
|
Facility
|
OP
|
$73.25
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.79 |
| Max. Negotiated Rate |
$435.30 |
| Rate for Payer: Aetna Commercial |
$62.26
|
| Rate for Payer: Aetna Medicare |
$36.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.61
|
| Rate for Payer: BCBS Complete |
$29.30
|
| Rate for Payer: BCBS Trust/PPO |
$435.30
|
| Rate for Payer: BCN Commercial |
$435.30
|
| Rate for Payer: Cash Price |
$58.60
|
| Rate for Payer: Cash Price |
$58.60
|
| Rate for Payer: Cofinity Advantage |
$51.27
|
| Rate for Payer: Cofinity Commercial |
$62.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.60
|
| Rate for Payer: Healthscope Commercial |
$65.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.94
|
| Rate for Payer: PHP Commercial |
$62.26
|
| Rate for Payer: Priority Health SBD |
$46.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.61
|
| Rate for Payer: UHC Core |
$38.16
|
| Rate for Payer: UHC Exchange |
$28.79
|
|
|
HC COMP BURN GARM STKNG KNEE TO T
|
Facility
|
IP
|
$73.25
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$65.92 |
| Rate for Payer: Aetna Commercial |
$62.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.61
|
| Rate for Payer: Cash Price |
$58.60
|
| Rate for Payer: Cofinity Advantage |
$51.27
|
| Rate for Payer: Cofinity Commercial |
$62.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.60
|
| Rate for Payer: Healthscope Commercial |
$65.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.94
|
| Rate for Payer: PHP Commercial |
$62.26
|
| Rate for Payer: Priority Health SBD |
$46.15
|
|
|
HC COMP BURN GARM STKNG TO THI NO
|
Facility
|
OP
|
$81.15
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300051
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$435.30 |
| Rate for Payer: Aetna Commercial |
$68.98
|
| Rate for Payer: Aetna Medicare |
$40.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.75
|
| Rate for Payer: BCBS Complete |
$32.46
|
| Rate for Payer: BCBS Trust/PPO |
$435.30
|
| Rate for Payer: BCN Commercial |
$435.30
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cofinity Advantage |
$56.80
|
| Rate for Payer: Cofinity Commercial |
$69.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.92
|
| Rate for Payer: Healthscope Commercial |
$73.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.86
|
| Rate for Payer: PHP Commercial |
$68.98
|
| Rate for Payer: Priority Health SBD |
$51.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.75
|
| Rate for Payer: UHC Core |
$42.28
|
| Rate for Payer: UHC Exchange |
$31.89
|
|
|
HC COMP BURN GARM STKNG TO THI NO
|
Facility
|
IP
|
$81.15
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300051
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$73.03 |
| Rate for Payer: Aetna Commercial |
$68.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.75
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cofinity Advantage |
$56.80
|
| Rate for Payer: Cofinity Commercial |
$69.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.92
|
| Rate for Payer: Healthscope Commercial |
$73.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.86
|
| Rate for Payer: PHP Commercial |
$68.98
|
| Rate for Payer: Priority Health SBD |
$51.12
|
|
|
HC COMP BURN GARM STMP CLS ORNG P
|
Facility
|
IP
|
$12.73
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
98300052
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$11.46 |
| Rate for Payer: Aetna Commercial |
$10.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.27
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cofinity Advantage |
$8.91
|
| Rate for Payer: Cofinity Commercial |
$10.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$11.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.55
|
| Rate for Payer: PHP Commercial |
$10.82
|
| Rate for Payer: Priority Health SBD |
$8.02
|
|
|
HC COMP BURN GARM STMP CLS ORNG P
|
Facility
|
OP
|
$12.73
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
98300052
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$377.01 |
| Rate for Payer: Aetna Commercial |
$10.82
|
| Rate for Payer: Aetna Medicare |
$6.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.27
|
| Rate for Payer: BCBS Complete |
$5.09
|
| Rate for Payer: BCBS Trust/PPO |
$377.01
|
| Rate for Payer: BCN Commercial |
$377.01
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cofinity Advantage |
$8.91
|
| Rate for Payer: Cofinity Commercial |
$10.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$11.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.55
|
| Rate for Payer: PHP Commercial |
$10.82
|
| Rate for Payer: Priority Health SBD |
$8.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.27
|
| Rate for Payer: UHC Core |
$6.63
|
| Rate for Payer: UHC Exchange |
$5.00
|
|
|
HC COMP BURN GARM STMP CLS STRCH
|
Facility
|
IP
|
$12.73
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
98300053
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$11.46 |
| Rate for Payer: Aetna Commercial |
$10.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.27
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cofinity Advantage |
$8.91
|
| Rate for Payer: Cofinity Commercial |
$10.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$11.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.55
|
| Rate for Payer: PHP Commercial |
$10.82
|
| Rate for Payer: Priority Health SBD |
$8.02
|
|
|
HC COMP BURN GARM STMP CLS STRCH
|
Facility
|
OP
|
$12.73
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
98300053
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$377.01 |
| Rate for Payer: Aetna Commercial |
$10.82
|
| Rate for Payer: Aetna Medicare |
$6.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.27
|
| Rate for Payer: BCBS Complete |
$5.09
|
| Rate for Payer: BCBS Trust/PPO |
$377.01
|
| Rate for Payer: BCN Commercial |
$377.01
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cofinity Advantage |
$8.91
|
| Rate for Payer: Cofinity Commercial |
$10.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$11.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.55
|
| Rate for Payer: PHP Commercial |
$10.82
|
| Rate for Payer: Priority Health SBD |
$8.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.27
|
| Rate for Payer: UHC Core |
$6.63
|
| Rate for Payer: UHC Exchange |
$5.00
|
|
